title: Outcomes of discharge after elective laparoscopic colorectal surgery with transversus abdominis plane blocks and enhanced recovery pathway.
abstract: BACKGROUND
  Enhanced recovery pathways (ERP) have been well shown to permit early recovery and discharge. The addition of a transversus abdominis plane (TAP) block to a standard pathway may improve these outcomes. We evaluated the addition of a TAP block to an established ERP.
  
  
  METHODS
  One hundred consecutive patients underwent elective laparoscopic colectomy by a single surgeon. A laparoscopic-guided TAP block was administered at the end of the procedure. Patients followed an established ERP that included overnight intravenous patient-controlled analgesia pump, diet and oral analgesia on postoperative day 1, and standardized discharge criteria.
  
  
  RESULTS
  The mean age was 60.5 years (range 15 to 92 years), 62 patients were female, and mean body mass index was 28.4 kg/m(2) (range 18 to 46 kg/m(2)). Median hospital stay was 2 days and mean length of stay was 2.9 days. Patients were grouped and analyzed by the day of discharge. Sixty-two percent of patients were discharged within 48 hours (27 on day 1; 35 on day 2). There was no mortality. Only 1 patient discharged within 48 hours of surgery developed a complication. Two patients were readmitted, both of whom were discharged more than 48 hours after surgery.
  
  
  CONCLUSIONS
  Transversus abdominis plane blocks with an ERP contribute to a short length of stay after laparoscopic colectomy, without increasing complication or readmission rates.
authors.affiliation: Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106-5047, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Favuzza
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery*; D019091:Critical Pathways; D004032:Diet; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D018709:Statistics, Nonparametric
keywords: ERP; POD; TAP; enhanced recovery pathway; postoperative day; transversus abdominis plane